Trump Authorizes States To Impose Work Requirement For Medicaid

President Trump is ready to let states make changes to Medicaid. That is the government-run health program for the poor. The administration says it will allow states - if they want - to add work requirements for able-bodied adults who seek Medicaid. A number of states have been asking for that authority, and that's the beginning of our discussion with NPR's Scott Horsley.

Hi, Scott.

SCOTT HORSLEY, BYLINE: Good morning, Steve.

INSKEEP: So work requirements - what's that mean exactly?

HORSLEY: Well, it could be actual work. It could also be other forms of what the government calls community engagement, such as job training or volunteer work or maybe caregiving. You said it. This is an authorization for states to add that requirement. It's not a requirement from the federal government. But the agency that oversees Medicaid says it's had requests from about 10 states. And so it's offering this kind of flexibility. We should stress this requirement would only be available for able-bodied adults, not children - and children are, of course, some of the biggest beneficiaries of Medicaid...

INSKEEP: Yeah.

HORSLEY: ...And not for people who become eligible for Medicaid because they are disabled.

INSKEEP: Does this strike a certain political chord for Republicans?

HORSLEY: Certainly. This is something that is popular with Donald Trump's base. He was at a rally in Missouri a few weeks ago, and he got a big round of applause when he talked about welfare reform. Critics, I should say, consider this unwarranted and maybe even mean-spirited. They note that a lot of people who get Medicaid now already work. They just don't earn enough money to buy their own health insurance.

And critics of this kind of move argue that more people on Medicaid would work if they had the assurance of good health that government assistance provides. Seema Verma, though, the woman who oversees Medicaid...

INSKEEP: Yeah.

HORSLEY: ...Before she went to work for the federal government, she was a consultant to states like Indiana and Kentucky that have been seeking this kind of flexibility. So it's no surprise that she would pioneer this kind of move.

INSKEEP: I don't want to get hung up on a word here, Scott, but you said welfare reform. When you say the word welfare, what that traditionally has meant is some kind of cash payment or food stamps to people who don't have a job or whatever. This is something different, though. Isn't it? This is health care.

HORSLEY: Well, in this case, I'm using the term that the president himself has used. And...

INSKEEP: That's what I mean, yeah.

HORSLEY: ...So you can define it lots of different ways. Remember, there's kind of a split among lawmakers - Republican lawmakers about how far the government should go in tackling popular entitlement programs like Social Security and Medicare. Medicaid, which is a program that benefits the poor, is perhaps a juicier target. Paul Ryan, the House speaker, has wanted to move aggressively in the new year to go after entitlement programs. The Republican Senate leader, Mitch McConnell, is much more wary about that. He says any such move to go after entitlements would have to be bipartisan. And that's not likely.

So it may be that the kind of welfare reform you are likely to see from the Trump administration in the new year will be this kind of administrative move, things that administration can do without the help of Congress. And other targets might be food stamps, which you mentioned.

INSKEEP: Well, now, there's another question. You're saying the administration can do this unilaterally without moving anything through Congress. Is that right?